TURP Specimens

I had a TURP done and prostate cancer was found. What will I find on my path report?

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

TURP, also called transurethral resection of the prostate or TUR, is a procedure that may be done to treat an enlarged prostate or to evaluate prostate cancer. A TURP is performed by passing a tube into the urethra (the thin tube that urine passes through) and identifying the area where the prostate has grown and is blocking the free and normal passage of urine, a condition referred to as benign prostatic hypertrophy, or BPH.

A tool is then used to scrape away the internal portion of the prostate gland that is causing the urethral blockage. These “scrapings” are then made into “chips”, which are thinly sliced samples that can be evaluated by the pathologist. The actual number of chips can vary greatly, depending on how much tissue the urologist removes. There may be as few as 10 to 20 chips, to as many as 150. This type of procedure is generally only used for relief of bad urinary obstruction from BPH. It is NOT technically a treatment for the cancer, as it only removes the central portion of the prostate, and further evaluation or treatment is needed if a tumor is found.

As far as the pathology results from these chips if cancer IS found, they are generally stage T1a or T1b prostate tumors. The difference between T1a and T1b is that T1a is limited and the microscopic appearance of the cancer cells (histology) is not aggressive. Furthermore, less than 5% of the chips have cancer, and the Gleason score is 7 or lower. T1b involves more than 5% of the chips or is a Gleason 8, 9, or 10.

Whereas T1b tumors are managed and treated like stage T2 prostate cancer (cancer felt on digital rectal exam), T1a tumors may be clinically insignificant, but it is hard to tell. The prostate is like an orange, with a central pulpy part that has storage tissue and a rind that is the glandular tissue. The central part is the portion that gets larger as a man gets older, while the rind is where the tumors start. The TURP procedure only removes the central part, and so the question is whether there is more tumor in the glandular tissue. In an elderly man who elects watchful waiting, this is not important. In a younger man with a longer anticipated survival, the urologist will go back about 6 months later and do more prostate biopsies. If these are negative, the risk of a rising PSA is 14% at 7 years. If any of the biopsies are positive, the patient is treated like a T1c prostate cancer.